ArticleBMJ global health2019
The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries.
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 124 papers, 3 of them syntheses that pooled it.
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Who cites it
124 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Minimum material requirements for hand hygiene in community settings: a systematic review.BMJ global health · 2025Pooled it
- Measurement in the study of human exposure to animal feces: A systematic review and audit.International journal of hygiene and environmental health · 2023Pooled it
- Diverse Health, Gender and Economic Impacts from Domestic Transport of Water and Solid Fuel: A Systematic Review.International journal of environmental research and public health · 2021Pooled it
- Growth, physical, and cognitive function in children who are born HIV-free: School-age follow-up of a cluster-randomised trial in rural Zimbabwe.PLoS medicine · 2024Trial
- Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya.AIDS and behavior · 2022Trial
- Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya.The Journal of nutrition · 2021Trial
- Historic drought in northern Kenya shifts diet and mobility away from traditional pastoralism as resource security and nutrition falter.Global environmental change : human and policy dimensions · 2026Article
- Study Protocol for the Daasanach Human Biology Project: A Longitudinal Study of the Impact of Drinking Water Salinity and Heat Stress on Water Insecurity, Hydration, Energetics, Hypertension, and Kidney Function in Northern Kenya.American journal of human biology : the official journal of the Human Biology Council · 2026Article
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- Dual Burden of Food and Water Insecurity Among SNAP Households with Children in the Southern United States.International journal of environmental research and public health · 2026Article
- Inequities in contraceptive use among adults in Lebanon: a national study.Journal of global health · 2026Article
- Changes in resource insecurity, sexual and mental health among young women after Kenya's 2024 heavy rains and floods.International health · 2026Article
- Associations between extreme weather events, mobility, and resource insecurities with HIV vulnerabilities among older adults in Moshi, Tanzania: Cross-sectional findings.International journal of STD & AIDS · 2026Article
- Addressing the Impacts of Water Insecurity on Infant Feeding: Policy Solutions for the US.Maternal & child nutrition · 2026Article
- Factors Influencing Water and Sweet Beverage Purchasing Decisions and Behaviours Among Low-Income Households in Four Peri-Urban Communities in Accra: An Exploratory Study.International journal of environmental research and public health · 2026Article
- Multilevel Determinants of HIV Prevention Among Urban Refugee Youth in Uganda: Baseline Findings from the Tushirikiane-4-Uthabiti Trial.AIDS and behavior · 2026Article
- Water Insecurity Is Associated with Sugar-Sweetened Beverage Consumption in a Small-Scale Population in Lowland Bolivia Experiencing Lifestyle Changes.Journal of the Academy of Nutrition and Dietetics · 2026Article
- Poor Water Quality and Food Insecurity in Ecuador: Disparities in Exposure and Associations With Young Child Feeding Practices.Journal of the Academy of Nutrition and Dietetics · 2026Article
- Housing and Water Insecurity as Structural Predictors of Intimate Partner Violence: A Cross-Sectional Study of People Living with HIV.AIDS and behavior · 2026Article
64 more citing papers are in PubMed but not listed here.
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Authors and funding
11 authors.
Funding
Abstract
objectiveProgress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.
methodsCross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use and storage; household food insecurity and perceived stress. We retained water insecurity items that were salient and applicable across all sites. We used classical test and item response theories to assess dimensionality, reliability and equivalence. Construct validity was assessed for both individual and pooled sites using random coefficient models.
findingsTwelve items about experiences of household water insecurity were retained. Items showed unidimensionality in factor analyses and were reliable (Cronbach's alpha 0.84 to 0.93). The average non-invariance rate was 0.03% (threshold <25%), indicating equivalence of measurement and meaning across sites. Predictive, convergent and discriminant validity were also established.
conclusionsThe HWISE Scale measures universal experiences of household water insecurity across low-income and middle-income countries. Its development ushers in the ability to quantify the prevalence, causes and consequences of household water insecurity, and can contribute an evidence base for clinical, public health and policy recommendations regarding water.
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